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Millions of Americans are getting health insurance because of the Affordable Care Act. One of the big groups to benefit from the law is adults under the age of 26 who can stay on their parents' policy, but just because you are covered does not mean you want mom and dad to know about that nagging rash. 

Many adults under the age of 26 are still on their parents' health plan. This can mean coverage but also paperwork that may or may not be kept private. (Photo courtesy of Shutterstock)

As of June 2012, the Center for American Progress said more than 3 million young adults got health coverage after the health reform law was passed. Maura Calsyn is the Center’s associate director of health policy. She said young people are the most uninsured age group in the U.S.

"They have very low rates of employer-sponsored insurance, especially those in lower-income or temporary jobs," Calsyn said. "There's this real misconception, I think, that everybody in this age group either has insurance or doesn’t want insurance, and that's simply not the case."

And Calsyn said that health coverage can be critically important.

"Nearly one in six young adults has chronic illnesses such as cancer or diabetes," Calsyn said.

But some young people on their parents' plans might not want their families to get a letter after a visit to the doctor for very personal reasons like reproductive health counseling or HIV testing.

Christopher Rasmussen works on health privacy issues at the Center for Democracy and Technology. He said the Health Insurance Portability and Accountability Act, better known as HIPAA, does give young people a way to keep their treatment private, even if their parents’ home is listed as the address on the policy.

“It allows an individual to ask that the explanation of benefits letter from an insurance company be provided to them at an alternative address," Rasmussen said.

But insurers can say no unless patients explain how they will pay the bill, and young people might not know the insurance company will send a letter listing the services provided, or that they can ask their insurer not to.

Plus, there is always the chance of human error. Add it all up, and health privacy advocates say the protections are far from ironclad.

In fact, there’s a bill in the California legislature right now sponsored by Sen. Ed Hernandez. He said its goal is, "to close loopholes in current state and federal laws to protect personal and sensitive health information of individuals covered under another person’s health policy."

The bill would forbid insurance companies from sending information about sensitive services. So, if a patient is treated for alcoholism or depression, they will not get anything about it in the mail unless they ask for it, or it is required by law.

Hernandez said if their privacy is not guaranteed, young people might not seek the treatment they need. But it is not just young people.

“Let’s say there is an abusive spouse, where the person may get some sensitive testing, whether it’s HIV or reproductive health issues, and they may actually not seek out the health care because they’re afraid that if their abusive spouse finds out that it may cause problems at home," Hernandez said.

Some insurance groups are against the bill, saying it would be difficult to put into practice. Hernandez is hopeful it has got enough support to pass. It was scheduled for its latest committee hearing Friday.

But Calsyn sees health privacy as a challenge nationwide.

"I think one of the key things is educating people that they have to be vocal about making sure that this information goes to who they want it to go to," Calsyn said.

And, as with every story you hear about the Affordable Care Act, all the challenges will become more acute as millions more Americans get health coverage in the coming months.